EXPERIMENTAL STUDIES

Safety and Performance of a Novel Intravascular Catheter for

Induction and Reversal of Hypothermia in a Porcine Model

Becky Inderbitzen, M.S.E., Steven Yon, Ph.D.,

Juan Lasheras, Ph.D., John Dobak, M.D.,
John Perl, M.D., Gary K. Steinberg, M.D.
Innercool Therapies, Inc. (BI, SY, JD), San Diego, California; Department of
Mechanical and Aerospace Engineering (JL), University of California at San Diego,
San Diego, California; Department of Neurology (JP), The Cleveland Clinic
Foundation, Cleveland, Ohio; and Department of Neurosurgery (GKS), Stanford
University School of Medicine, Stanford, California

OBJECTIVE: This study was undertaken to assess the acute safety and feasibility of rapidly inducing, maintaining,
then reversing hypothermia using a novel heat transfer catheter and a closed-loop automatic feedback temper-
ature control system to overcome limitations imposed by current clinical practices used for perioperative cooling
and warming.
METHODS: Six swine (mean mass, 53.8 ⴞ 3.6 kg) were studied. The heat transfer catheter was placed in the inferior
vena cava via the femoral vein. Hypothermia to 32°C was induced, maintained for 6 hours, then reversed to 36°C.
The time needed to induce and reverse hypothermia was recorded via continuous temperature monitoring of the
lower esophagus, cerebrum, and rectum. Electrocardiography provided continuous monitoring, and blood draws
were made at baseline and at 2-hour intervals. Examination of the catheter in situ was performed after the animals
were killed.
RESULTS: Cooling from 36.2 to 32.0°C was rapid and uniform (mean, 7.3 ⴞ 0.7°C/h), with animals reaching the
target temperature within 60 minutes. Rewarming was also easily controlled, with animals’ temperatures
reaching 36°C within 130 minutes. No arrhythmia was observed, and all hematological variables were within the
normal range for swine. There was no evidence of hemolysis or platelet changes. Little to no thrombosis was
observed.
CONCLUSION: The data presented here suggest that rapid induction and reversal of hypothermia are technically
possible using a core intravenous cooling catheter; this method would provide a safe, rapid, and exquisitely
reproducible way to induce hypothermia with subsequent restoration of normothermia.
(Neurosurgery 50:364–370, 2002)
Key words: Catheter, indwelling; Hypothermia, induced; Rewarming; Swine

T
he protective effects of hypothermia against cerebral
injury have long been recognized; the use of induced
hypothermia as a protective adjunct to neurosurgery
was initiated in the mid-1950s (5, 25). Even small reductions
(2–3°C) in brain temperature during temporary vessel occlu-
sion were discovered to be markedly protective against isch-
emic brain damage in animals in independent studies pub-
lished in 1987 (6) and 1990 (29). Numerous experimental
animal studies have been performed in the ensuing years to
assess the effect of mild hypothermia on permanent versus
temporary vessel occlusion (30, 34), to determine the proper
dosing of mild hypothermia in terms of temperature (2, 10, 13,
23, 26, 42) and onset time (14, 27, 42), and to elucidate the
neuroprotective mechanisms of mild hypothermia (14, 15, 17,
18, 26). The use of mild hypothermia (ⱖ32°C) for procedures
requiring craniotomy was first reported in 1992 (7). In a 1994
study (8) involving 65 neuroanesthesiologists from 41
university-affiliated centers, 71% reported using induced hy-
pothermia for cerebral protection during cerebral aneurysm
surgery. More recent reports indicate that mild hypothermia
has also been adopted as a neuroprotectant during aneurysm
surgery in Europe (11, 40) and Japan (16).
Surface cooling and warming via a water-filled blanket or
forced air is the most commonly used modality for inducing

364 Neurosurgery, Vol. 50, No. 2, February 2002


and reversing hypothermia in the perioperative setting. These
systems transfer relatively little heat, but they are easy to
implement (5). Rapid cooling below 35°C in the anesthetized
patient requires the use of a more active method to remove
body heat from the patient, because arteriovenous shunt va-
soconstriction limits heat transfer with the environment to
maintain metabolic heat in the body core (3, 21). Surface
warming methods alone, as well as those that are augmented
with warmed intravenous fluids and anesthetic gases, are
then often inadequate to rewarm the patient to normothermia
(i.e., 36°C) before the end of the operation (1, 12).
This study was undertaken to assess the acute safety and
feasibility of rapidly inducing, maintaining, then reversing
hypothermia using a novel heat transfer catheter and a closed-
loop automatic feedback temperature control system (Inner-
cool Therapies, Inc., San Diego, CA). The catheter has a flex-
ible metal heat transfer element with unique features that
enhance heat transfer across the surface (Fig. 1). The entire
catheter is coated with a covalently bonded heparin matrix to
mitigate thrombosis. The heat transfer medium is cooled and
heated in the thermal control unit and recirculated through
the catheter to effect local heat exchange within the vascula-
ture. Study safety end points were selected to cover those
potential consequences most notably associated with hypo-
thermia therapy: cardiac dysfunction (22, 41) and enzymatic
changes in the coagulation cascade (36). Other safety end
points associated with the catheterization procedure were
catheter thrombosis and vascular injury.
MATERIALS AND METHODS
The experiments were performed on six cross-bred
Yorkshire-Hampshire domestic swine (Suis suis) weighing be-
tween 49.2 and 59.5 kg. All experiments were conducted in
accordance with the Guide for the Care and Use of Laboratory
Animals (National Institutes of Health Publication No. 86-23,
revised 1985) and with the approval of the Animal Care and
Use Committee of the Puget Sound Veterans Affairs Medical
Center. Pigs were selected as the animal model because their
physiological responses to hypothermia in conscious and
anesthetized states demonstrate metabolic and thermoregula-
tory responses to hypothermia similar to those of humans (4,
24, 37).
FIGURE 1.
Photograph of
the heat trans-
fer catheter.
The catheter
diameter is
14-French (4.7
mm).
Neurosurgery, Vol. 50, No. 2, February 2002
Intravascular Cooling and Warming in Swine
Surgical preparation
Animals were sedated with xylazine (0.1 mg/kg i.m.) and
tiletamine-zolazepam (5 mg/kg i.m.), intubated, and placed
on a closed-circuit ventilator with general isoflurane anesthe-
sia (1.5–2.25%, to effect) supplemented with room air. Respi-
ratory rate and tidal volume were set to maintain arterial
blood gases within physiological limits. Electrocardiography
limb leads were placed, and Lead II was monitored
(Medtronic Physio-Control, Redmond, WA) throughout the
experiment; the heart rate was recorded at 30-minute inter-
vals. The animals were not heparinized.
An 18-French esophageal stethoscopic temperature probe
was placed in the lower third of the esophagus to measure the
animals’ core temperature. A small hole was drilled through
the skull at the approximate intersection of the central sulcus
and the sagittal fissure, and a 22-gauge 18-mm needle tem-
perature probe (Mallinckrodt, Inc., St. Louis, MO) was placed
into the dura mater of the cerebral cortex. A 9-French temper-
ature probe (Mallinckrodt, Inc.) was placed in the rectum. A
7-French central venous catheter (CVC) was inserted through
the jugular vein and positioned in the superior vena cava for
drawing blood. The 14-French heat transfer catheter was in-
serted via a 16-French introducer sheath (Cook Medical, West
Lafayette, IN) into the femoral vein and positioned in the
inferior vena cava (IVC) so that the distal tip was at the level
of the diaphragm. Fluoroscopy (Phillips International, Am-
sterdam, The Netherlands) was used for verifying placement
of the catheter. The inguinal wound was closed, and the
animal was draped with an uninflated warming blanket
(Mallinckrodt, Inc.).
Temperature control and monitoring
Core temperature was controlled via a closed-loop auto-
matic control unit connected to the heat transfer catheter via a
disposable administration set (Innercool Therapies, Inc.). The
esophageal temperature was used as the input parameter to
drive the control unit. The control unit was set to a target
temperature of 32°C at the initiation of hypothermia and was
reprogrammed to 36°C to reverse hypothermia. Forced-air
heating (38–42°C) was supplied (Mallinckrodt, Inc.) to the
warming blanket once the hypothermic target temperature
was achieved to ensure equilibration of temperature between
the core and the peripheral thermal compartments. Forced-air
heating was maintained during rewarming to facilitate heat
transfer to the periphery, whereas the heat transfer catheter
warmed the core. The hypothermic period was maintained for
6 hours after induction, and the reversal period lasted as long
as it took to achieve normothermia (36°C). Room temperature
was maintained at approximately 20°C throughout all exper-
iments. Animal temperatures and temperature control system
operating parameters were continuously recorded at 1-second
intervals on a notebook computer using customized software
(National Instruments, Austin, TX).
365
366 Inderbitzen et al.
Hematology
Venous blood samples were obtained before hypothermia
induction and at 2-hour intervals throughout the experiment.
Plasma fibrinogen and d-dimer content, prothrombin time,
and activated partial thromboplastin time were determined to
assess hypothermia-induced indices of fibrinolysis and coag-
ulation. Complete blood counts and basic metabolic panels
(serum concentrations of glucose, urea nitrogen, creatinine,
sodium, potassium, chloride, and carbon dioxide) were deter-
mined to assess hypothermia-induced whole blood changes.
In addition, activated clotting times were measured with a
point-of-care coagulation instrument (International Techni-
dyne Corp., Edison, NJ) at the same time points. All param-
eters were inspected for trend changes during the treatment
period.
Angiography
To assess vascular patency, approximately 10 ml of contrast
medium was injected through the sheath introducer in the
ipsilateral femoral vein at baseline and 2, 4, and 6 hours
afterward, and venograms were recorded on a videocassette
recorder. A final venogram was obtained at the end of the
procedure and before the animals were killed. The position of
the catheter in the vein was documented for comparison with
vascular wall damage.
Gross pathology
At the end of the experiment, the animals were adminis-
tered a dose of sodium heparin (150 U/kg i.v.) then killed
with an overdose of sodium pentobarbital. A perfusion cath-
eter was placed proximal to the catheter entry site, and in situ
perfusion fixation was performed at 100 mm Hg by flushing
the vessel first with saline and then with 10% neutral buffered
formalin.
The heat transfer catheter and associated vascular tree (fem-
oral and iliac veins and IVC) were carefully isolated in situ.
The vessels were incised longitudinally; the catheter and ve-
nous lumen were inspected for adherent thrombus, and the
endothelium was inspected for vascular injury. The degree of
thrombosis and/or vascular injury was assessed according to
a standard 5-point scale used by the North American Science
Associates (Northwood, OH), in which no thrombus or injury
is Grade 0 and occlusive thrombosis is Grade 5. Photographs
were taken grossly. The CVC and associated vessels were
isolated and examined in a similar manner. The CVC was
used as a control for comparison of thrombus development
and vascular injury.
Statistical analysis
Differences in catheter thrombosis and vascular injury be-
tween the group with the heat transfer catheter and the con-
trol CVC group were compared using a two-tailed McNemar
test after dichotomizing the results (0 versus ⬎0). P ⬎ 0.05
was considered significant.
Neurosurgery, Vol. 50, No. 2, February 2002
RESULTS
Six pigs (mean body weight, 53.8 kg) completed the proto-
col successfully. Core temperatures were dropped to 32.0°C
within an hour of the onset of hypothermia treatment, main-
tained within 0.1°C for the balance of the 6-hour hypothermia
period, then reversed to 36°C within 2.5 hours of hypothermia
cessation. The overall duration of the experiment was depen-
dent on the rewarming duration and lasted between 456 and
504 minutes (mean, 480 ⫾ 19 min) for the six animals.
Temperature control and monitoring
The average core cool-down rate was 7.3 ⫾ 0.7°C/h and the
rewarming rate was 2.2 ⫾ 0.3°C/h. One animal was omitted
from the overall cooling calculations because it cooled pas-
sively to 34.2°C (versus a mean of 36.1°C for the other five
animals), yielding an unusually high rate of catheter cooling.
Average coincident cooling rates for the cerebrum and the
rectum were 6.2 ⫾ 0.4°C/h and 4.9 ⫾ 0.4°C/h, respectively,
and average warming rates were 2.1 ⫾ 0.4°C/h and 2.2 ⫾
0.4°C/h, respectively. Core cooling and warming rate calcu-
lations were based on the temperature range in which the
system was operating under maximal cooling power; average
values for the six animals ranged from 36.2 to 32.3°C for
cooling and from 32.2 to 36.0°C for warming. Cooling and
warming rates for the cerebral and rectal compartments were
based on the temperature changes that occurred during the
time that it took the core compartment to reach hypothermic
and normothermic targets. The rate of cerebral and rectal
cooling was necessarily slowed down after the core reached
the hypothermic target, because the temperature control sys-
tem is programmed to operate in a low-power maintenance
mode once the core reaches the target temperature. For the
first three animals, rewarming was performed with the warm-
ing blanket pulled up to the animal’s neck; for the last three
animals, the blanket covered the animal’s head to mitigate
shivering. Covering the head of the animal also improved the
warming rate of the core, cerebral, and rectal compartments.
Figure 2 is a representative profile of the three thermal
compartments monitored. The brain temperature started out
cooler than the core temperature, whereas the rectal temper-
FIGURE 2. Representative profile of hypothermia induction,
maintenance, and reversal in three different thermal
compartments.
 Intravascular Cooling and Warming in Swine
ature was higher, which is consistent with the thermal com-
partmentalization of patients undergoing anesthesia (38). The
brain temperature initially dropped to lower than the core
temperature after the core reached 32°C because of the pref-
erentially higher blood flow to the brain. There was a consid-
erable delay in the cooling of the rectum, however, and this
compartment was approximately 2°C warmer than the core
when the hypothermic target was reached. Both cerebral and
rectal compartments slowly equilibrated with core tempera-
ture after peripheral heating was initiated approximately 50
minutes into the procedure.
Cardiac rhythm
There were no incidences of arrhythmia or other irregular-
ity in the cardiac rhythm during the experimental period for
any animal. On electrocardiograms, a reduction in heart rate
was the only impact that was noted. The induction of hypo-
thermia lowered the heart rate, and the reversal of hypother-
mia returned the heart rate to baseline values. In this set of
animals, anesthesia hypothermia caused a 10-beats/min re-
duction in heart rate; baseline values dropped from 95.7 ⫾
13.8 to 85.7 ⫾ 13.5 beats/min by 1 hour after hypothermia
induction. The heart rate increased slightly during hypother-
mia maintenance after the animals were covered with a
warming blanket, so that heart rate increased from 91.5 ⫾ 17.5
to 95.7 ⫾ 10.7 beats/min with the reversal of hypothermia.
Hematology
Interanimal variation was nominal across the monitoring
period, and all values were considered within the normal
range for swine. There were no trend changes to suggest a
thermoregulatory effect in any parameter. There was also no
fibrinolysis or coagulopathy, as evidenced by unchanged fi-
brinogen and fibrin split product levels, prothrombin time,
activated partial thromboplastin time, and activated clotting
times.
Angiography
Venograms demonstrated that the catheterized iliac vein
and the IVC remained patent throughout the duration of the
experiment for each animal. No visible thrombosis or vaso-
constriction developed in any pig. All catheters touched the
lumen wall to varying degrees; only one catheter demon-
strated less than 25% contact over the metal section. All but
one of the catheters in contact with the vascular wall seemed
to be well centered in the IVC over the distal half of the metal
section.
Catheter thrombosis
Three of six temperature control catheters had no adherent
thrombus at the end of the experiment. One catheter had a
small, white adherent thrombus; one had one small, red ad-
herent thrombus; and one had a strand of adherent thrombus
and a moderate-sized red thrombus that covered the circum-
ference of the catheter. The average score for catheter throm-
bosis was 0.67. Catheter thrombus was found over very lim-
Neurosurgery, Vol. 50, No. 2, February 2002
367
ited areas at sites in which angiograms indicated that the
catheter had been in contact with the vessel wall.
Only one of six control catheters had no adherent thrombus
at the end of the experiment. One catheter had a small, thin
strand of adherent thrombus; two had one small, adherent
thrombus each; one had a small thrombus at the catheter tip
that occluded the blood draw lumen; and one had a
moderate-sized thrombus that covered the circumference of
the catheter. The average score for CVC catheter thrombosis
was 0.83. The difference in catheter thrombosis scores was not
statistically significant (P ⫽ 0.63).
Vascular injury
Four of six vessels in which the temperature control cath-
eter had been placed contained no adherent clots or lesions.
One vessel had one focal lesion, and one had two focal lesions.
The average injury score was 0.50. Two vessels in which CVC
catheters had been placed contained no adherent clots or
lesions. Four vessels had one focal lesion. The average injury
score was 0.67. The difference in vascular injury scores is not
statistically significant (P ⫽ 0.50).
DISCUSSION
This study demonstrates the safety and effectiveness of
rapidly inducing and reversing whole-body hypothermia
with a completely closed-loop system in a large mammal. This
catheter-based system is unique in that whole-body hypother-
mia was induced and reversed without the fluid infusion
typically described in the medical literature. The unique prop-
erties of the catheter design facilitate heat transfer between the
body tissues and the thermal control unit’s heat exchanger to
effect wide-ranging, rapid heat flux.
Thermal energy balance: Cooling
Hypothermia can be induced only by putting the body into
a negative heat balance (i.e., to remove more heat from the
body than it produces at any given time). Body tissues pro-
duce heat as a by-product of metabolism. Metabolic heat
production is 0.83 kcal䡠kg⫺1䡠°C⫺1 for an average conscious
person at rest in a temperate environment.
In the animals used in this study, reducing the core tem-
perature from 37 to 32°C would theoretically require 223 kcal
of energy. However, anesthesia induces core hypothermia via
two primary mechanisms. First, anesthesia reduces the vaso-
constriction threshold that results in core-to-periphery heat
redistribution marked by a core temperature drop within the
first hour of anesthesia induction. Second, anesthesia reduces
metabolic energy production by approximately 35%, which
produces an overall core temperature drop within the first
hour of anesthesia administration and a subsequent reduction
in body heat content (4, 28, 39). In this study, hypothermia
was induced during the first hour of anesthesia, after the
average core temperature had dropped 0.8°C. Therefore, the
normal redistribution of body heat and decreased metabolism
contributed to the core-cooling rate reported for these ani-
mals. Correcting for decreased metabolic heat production and
altered heat distribution, the excess body heat required to
368 Inderbitzen et al.
reduce core temperatures from 37 to 32°C was 102 kcal.
Ninety-one percent of this heat was removed within 29 min-
utes of hypothermia induction. The rate of cooling correlates
to an effective cooling power of 221 W. System operating
parameters indicated that the heat transfer catheter was re-
sponsible for removing 91% of this energy, or 202 W. The
excess of 19 W is equivalent to 0.3°C. The difference in power
may reflect some heat lost to the environment. However, it is
likely that most of the energy was still being stored in body
compartments that had not yet equilibrated with core temper-
ature. This phenomenon is reflected in Figure 2, which shows
that rectal temperatures reflecting the gut compartment were
still more than 1°C higher than the core when the core hit the
hypothermic target. The rate of cooling observed in this study
using the heat transfer catheter was 7.3 ⫾ 0.7°C/h.
Thermal energy balance: Warming
Reversing hypothermia is theoretically easier to accomplish
than inducing it, because the warming system needs only to
augment the body’s metabolic heat production. Warming the
hypothermic patient using surface heat induction methods is
fraught with difficulty, however, because the peripheral vas-
culature is normally constricted below 34°C to maintain core
heat (21). The very mechanism that is intended to limit cuta-
neous heat loss also limits cutaneous heat gain because blood
is shunted to the core. In addition, normally protective ther-
moregulatory mechanisms that increase core heat are im-
paired after cessation of hypothermia because of the anesthet-
ics (39) and opioids administered to treat surgical pain (19,
20). In fact, surface warming was shown to merely prevent
loss of body heat rather than to increase it in one clinical study
aimed at assessing means of mitigating redistribution hypo-
thermia in bypass patients (33).
In the study reported herein, metabolic heat production
increased the core temperature of the animals by 0.2°C after
cessation of hypothermia and before the initiation of rewarm-
ing. The average rewarming rate of 2.2°C/h reflects the in-
crease in body heat that occurred while the heat transfer
catheter was operating in the warming mode. This rate of
increase corresponds to an overall power increase of 70 W.
System operating parameters indicated that 96% of this
power, or 67 W, was provided by the heat transfer catheter.
The excess 3 W corresponds to a 0.2°C increase in whole-body
heat content and was likely a result of metabolic heat produc-
tion. This assertion was supported in a report by Lossec et al.
(24), who demonstrated that metabolic heat production in
piglets created a net heat gain when core temperatures were
below 34°C during ambient warming. The use of the warming
blanket while rewarming the animals served only to prevent
the loss of body heat being generated in the core as a result of
the heat transfer catheter.
Catheter thrombogenicity
Follow-up studies were performed to assess catheter
thrombogenicity during a 24-hour indwelling period. Six
swine were used; three animals had the heat transfer catheter
placed in the IVC, and three had a continuous cardiac output
Neurosurgery, Vol. 50, No. 2, February 2002
catheter (Baxter Healthcare Corp., Irvine, CA) placed in the
IVC. Neither device was activated. The animals were killed at
the end of the 24-hour period, and the IVC was isolated and
transected to examine the catheters in situ. The amount of
thrombus formed over the catheters was comparable; how-
ever, veins in which the continuous cardiac output catheter
had been placed developed mural thrombi, whereas those in
which the heat transfer catheter had been placed did not.
Clinical application
A clinical trial (Innercool Therapies, Inc., San Diego, CA) is
under way to assess the safety of this catheter-based heat
transfer system for inducing and reversing hypothermia in
the setting of unruptured aneurysm surgery. Eighty-five pa-
tients have been studied thus far, with no system-related
adverse events reported. Cooling and warming rates attrib-
uted to the activated system are 5.0 and 2.0°C/h, respectively.
Differences from the swine data can be attributed to the
relative differences in body mass, cardiovascular function,
and level of vasodilation.
Cooling blankets typically remove or add very little body
heat. Core cooling rates ranging from 0.7 ⫾ 0.8°C/h (1) and
1.0 ⫾ 0.4°C/h (12) to 1.7 ⫾ 0.5°C/h (31) have been reported
for anesthetized patients. However, none of these reports of
cooling rate refers to the fact that the average loss of core
temperature as a result of anesthesia induction alone is ap-
proximately 1.5°C/h in the first hour of anesthesia (28).
Similarly, Rajek et al. (33) reported that convective air warm-
ing only prevents peripheral heat loss from internal warming
rather than actively warming the core.
CONCLUSIONS
Inducing and reversing hypothermia with an endovascular
approach was shown to be effective in pigs and in a limited
number of patients. Blood flow is the primary heat transfer
mechanism in the body and controls the relative temperatures
of each perfused tissue bed. Approximately 60% of the total
blood flow mass is directed to the brain and core organs,
whereas less than 10% is directed toward the skin and sub-
cutaneous fat; therefore, cooling the bloodstream before its
distribution through the body serves to preferentially cool the
brain and core organs, regardless of the vascular tone in
the periphery. The same principle can be applied to reversing
the hypothermic state. It is this direct heat transfer that
makes the rapid administration of warmed or cooled intrave-
nous fluid effective in managing body temperature (3, 32).
Rapid induction methods that involve the administration of
large volumes of fluid (9), however, are not considered prac-
tical for use in a perioperative setting.
The minimally invasive system may be more effective than
currently used surface cooling and warming methods and
may be more practical than methods that require blood and
fluid transfer. Moreover, the thrombogenicity profile of the
device is comparable to that associated with CVC, which is
placed for up to 10 continuous days in clinical practice. The
14-French diameter of the catheter is comparable to that of
Greenfield vena cava filters (12- to 24-French diameter), which
 Intravascular Cooling and Warming in Swine
are placed chronically to prevent pulmonary emboli. Use of
the thermal control catheter may therefore pose a similar 4 to
5% associated risk of deep vein thrombosis. Potential clinical
applications for this unique system include intracranial sur-
gery, cardiac surgery, stroke, head injury, and control of fever
in patients in the intensive care unit.
Received, May 8, 2001.
Accepted, September 13, 2001.
Reprint requests: Becky Inderbitzen, M.S.E., Innercool Therapies,
Inc., 3931 Sorrento Valley Boulevard, San Diego, CA 92121.
Email: beckyi@innercool.com
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COMMENTS
This article describes a new catheter that rapidly induces
and maintains hypothermia. Smaller intravascular catheters
have cooling capacities that are similar to those of surface
cooling methods—approximately 2°C/h. The 14-French cath-
eter is placed through a 16-French introducer, and hypother-
mia is induced very rapidly at 7°C/h. During the 6-hour
period of insertion, little thrombus formation was noted in
pigs. The main concern with its use is femoral vein thrombosis
with prolonged insertion. It is expected that the complication
rate will be approximately 5%. We do not have a proved or
accepted indication for therapeutic hypothermia, except dur-
ing certain cardiac procedures. Indications for hypothermia
require rapid cooling induction in patients with head injuries
or stroke and in those in cardiac arrest or who are having
aneurysm surgery. One way to exploit the capability of rapid
cooling by an intravascular system such as this one while
minimizing the complications is to use intravascular tech-
niques only for hypothermia induction. Whereas hypother-
mia induction in patients with neurological diseases likely
need to be very rapid, rewarming almost certainly must be
done slowly, and maintenance of hypothermia with surface
techniques is not a problem. It seems that a combination of the
two techniques would reduce complication rates and provide
optimal temperature control when prolonged hypothermia is
needed.
Guy L. Clifton
Houston, Texas
There are always unanswered potential problems early in a
study. To maintain the integrity of the scientific process, in-
vestigators independent of commercial interest and funding
need to confirm the original work and examine the problems.
Some areas for further study include the lack of a control
group, the relationship of the pig’s responses to human re-
sponses when this system is used, the choice of an anesthetic
regimen that has real relevance to human neuroanesthetic
management, and the risks (or the lack thereof) of microem-
bolization from a warm catheter gradient to cooler blood. The
accumulation of this body of knowledge will eventually de-
fine the clinical utility of this new technology.
Gregory Janelle
Roy F. Cucchiara
Neuro-Anesthesiologists
Gainesville, Florida
The authors used a novel intravascular catheter to produce
hypothermia in six pigs. The heat transfer catheter was effec-
tive in inducing and reversing hypothermia via an endovas-
cular route. The utility of temperature manipulation is cur-
rently being evaluated in a variety of settings. If this
technology can be applied safely in humans, the rapid induc-
tion and precise control of temperature regulation provided
by this device may be key factors in improving the effective-
ness of hypothermia.
Christopher L. Taylor
Dallas, Texas
Warren R. Selman
Cleveland, Ohio

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